Summaries of health policy coverage from major news organizations

Research Roundup: Virtual Medicine And Readmissions; Lack Of Women, Elderly In Heart Studies

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Journal of the American Medical Association: Effect Of A Postdischarge Virtual Ward On Readmission Or Death For High-Risk Patients
High-risk adult hospital discharge patients in Toronto were randomly assigned to either the virtual ward or usual care. A total of 1923 patients were randomized ... Patients assigned to the virtual ward received care coordination plus direct care provision (via a combination of telephone, home visits, or clinic visits) from an interprofessional team for several weeks after hospital discharge. ... In a diverse group of high-risk patients being discharged from the hospital, we found no statistically significant effect of a virtual ward model of care on readmissions or death at either 30 days or 90 days, 6 months, or 1 year after hospital discharge (Dhalla et al., 9/30).

Journal of Surgical Research: Is More Always Better?The Association Between Hospital Care Intensity And Surgical Outcomes In Medicare Patients
Hospitals’ care intensity [HCI] varies widely across the United States. Payers and policy makers have become focused on promoting quality, low-cost, efficient health care. ... Using national Medicare data in this retrospective cohort study, we identified 706,520 patients at 2544 hospitals who underwent 1 of 7 major cardiovascular, orthopedic, or general surgical operations. ... Failure-to-rescue rates were lower at high–care intensity hospitals. Conversely, care intensity explains a very small proportion of variation in failure-to-rescue rates across hospitals (Sheetz, Dimick and Ghaferi, 9/30).

JAMA Internal Medicine: Underrepresentation Of Women, Elderly Patients And Racial Minorities In The Randomized Trials Used For Cardiovascular Guidelines
The American College of Cardiology/American Heart Association (ACC/AHA) guidelines are frequently used to guide cardiovascular care. Randomized controlled trials (RCTs) are considered to be the highest level of evidence and are cited in these guidelines whenever available. However, RCTs can have limited external validity. To examine their generalizability, we examined the percentage of enrollment and reporting of sexes, races, geographic distribution, and age groups in the RCTs cited in the ACC/AHA guidelines for atrial fibrillation (AF), heart failure (HF), and unstable angina/non–ST-segment elevation myocardial infarction (acute coronary syndromes [ACS]). ... Our results suggest that women, elderly patients, and those of nonwhite racial backgrounds are underrepresented in the RCTs of the ACC/AHA guidelines for [these diseases] (Sardar et al., 9/29).

JAMA Internal Medicine: Assessing The Safety And Effectiveness Of Devices After US Food And Drug Administration Approval
Post-marketing surveillance is critical to evaluating the safety and effectiveness of medical devices. The US Food and Drug Administration (FDA) may order the manufacturer of a high-risk device to conduct post-marketing surveillance studies, known as post-approval studies (PASs), at the time of approval. ... The FDA has never issued a warning letter or penalty owing to study delays, inadequate progress or any other issue related to a PAS. ... Some studies generated significant clinical findings. ... small sample sizes, delays in reaching protocol agreement, and lack of availability of findings may hinder their ability to be clinically useful. ... Improved completion and accessibility of PASs could help answer important questions of safety and effectiveness about medical devices (Reynolds et al., 9/29).

The National Governors Association: The Role Of Physician Assistants In Health Care Delivery
Many experts see PAs [physician assistants] as important contributors to emerging strategies to deliver health care more efficiently and effectively, but important barriers exist that could slow the growth of the profession. For example, state laws and regulations may not be broad enough to encompass the professional competencies of PAs. In addition, state statutes and regulations impose widely diverse restrictions on physicians' ability to delegate authority to PAs, which, in some instances, are overly strict. ... In addition, PA training programs face ... [a] shortage of clinical training locations .... Finally, limited data indicate that PAs, like physicians, respond to economic incentives by shifting away from primary care and underserved communities in favor of higher-paying specialty care (Dunker, Krofah and Isasi, 9/22).

Health Affairs: The Impact Of Recent CHIP Eligibility Expansions On Children's Insurance Coverage, 2008–12
Following the reauthorization of the Children's Health Insurance Program (CHIP) in 2009, fifteen states raised their CHIP income eligibility thresholds to further reduce uninsurance among children. We examined the impact of these expansions on uninsurance, public insurance, and private insurance among children who became newly eligible for CHIP after the expansions. Using a difference-in-differences approach, we estimated that the expansions reduced uninsurance by 1.1 percentage points among the newly eligible, cutting their uninsurance rate by nearly 15 percent (Goldstein, Kostova, Foltz and Kenney, 9/24).

Health Affairs: The Physician Payments Sunshine Act
The [Physican Payment Sunshine Act, a part of the 2010 federal health law] requires manufacturers of drugs, devices, biologics, and medical supplies ... to report to CMS on three broad categories of payments or "transfers of value" ... The first year of implementation has presented a number of technical challenges for CMS. The agency's website has twice experienced glitches that required it to shut down, and physician reports of inaccurate data have prompted the agency to withhold as much as one-third of the data ... The full effects of the PPSA will likely not be felt for several more years ... However, even those who champion the program agree that simple disclosure is not sufficient to address financial conflicts of interest. Physicians and research centers will also need a reliable framework for determining what kinds of relationships are appropriate, useful and beneficial (Richardson, 10/2).

Journal of Disability Policy Studies: Gaps In Timely Access To Care Among Workers By Disability Status
Using data from the 2006–2010 National Health Interview Surveys, in this study, we document the characteristics and health insurance profiles of workers with a disability and consider the extent to which these factors are correlated with the ability to access adequate and timely health care. We find significantly higher rates of reported difficulties accessing timely health care for cost-related and structural reasons among employed adults with self-reported health conditions limiting the ability to work than among their non-work-limited peers, even after controlling for personal characteristics and health insurance coverage. The findings suggest that although the ACA will improve access to health insurance, it remains to be seen whether it will substantially reduce the likelihood that workers with disabilities will experience barriers to health care access relative to their non-disabled peers (Hyde and Livermore, September, 2014).

Here is a selection of news coverage of other recent research:

The New York Times’ The Upshot: Given Choice, Parents Pick Cheaper Medical Procedure For Children
It is common wisdom that patients don't like to think about cost when it comes to health care. But what if the problem is that they're so rarely even given that information? A recent study in the Annals of Surgery found that parents who were asked to decide which form of surgery their children should undergo and told about the price difference tended to select the cheaper option (Rosenthal, 10/1).

MinnPost: America's Waistlines Keep Expanding, CDC Study Finds
U.S. obesity rates may have stabilized in recent years, but our waistlines are still expanding, according to new research published late last week in the Journal of the American Medical Association (JAMA). That's not good news. A large waistline — a sign of excessive abdominal fat — is a risk factor for a variety of serious medical conditions, including type 2 diabetes and heart disease, no matter what weight category (normal, overweight or obese) your body mass index (BMI) puts you in. It's also a risk factor for premature death. For these reasons, experts at the National Heart, Lung and Blood Institute (NHLBI) and elsewhere recommend that women not let their waistline expand beyond 35 inches and men beyond 40 inches (Perry, 9/22).

MinnPost: Overtreatment Of 'Mild' Hypertension Causing More Harm Than Good
Millions of people around the world are being treated unnecessarily with drugs for "mild" hypertension (high blood pressure), exposing them to more potential harm than good and wasting health care resources, according to a recent commentary in the journal BMJ. The commentary, whose authors include Dr. Stephen Martin of the University of Massachusetts Medical School and Dr. James Wright of the University of British Columbia, who is also a coordinating editor of the Cochrane Hypertension Review Group, was published last week in conjunction with BMJ’s ongoing "Too Much Medicine" campaign (Perry, 9/23).

Reuters: One In Four Kids On ADHD Meds Gets Therapy Too
Most kids in the U.S. who take medication for attention deficit hyperactivity disorder (ADHD) are not getting behavioral counseling therapy as well, according to a new study. The analysis, based on a commercial insurance database, also found the proportion of kids with ADHD who do get therapy varies widely from region to region. "Although I expected rates of psychotherapy to differ across counties, I was surprised by the amount by which they differed," said Dr. Walid F. Gellad, lead author of the new research letter (Doyle, 9/25).

Reuters: Long-Acting Reversible Contraceptives Best For Teens: Pediatricians
For adolescents who choose not to abstain from sex, the American Academy of Pediatrics favors long-acting reversible contraceptives, such as contraceptive implants and intrauterine devices. All methods of hormonal birth control, including contraceptive pills, are safer than pregnancy, Dr. Mary A. Ott from the Indiana University School of Medicine in Indianapolis, Indiana told Reuters Health by email. But long acting reversible contraceptive (LARC) methods, including the contraceptive implant and the intrauterine device (IUD), should be the first-choice contraceptive methods for adolescents who choose not to be abstinent, she added. Today in the medical journal Pediatrics, Ott and colleagues on the AAP’s Committee on Adolescence updated the organization’s 2007 policy statement on prescribing contraception for adolescents (Boggs and Lapid, 9/29).

The Hill: Cancer Costs Skyrocketed Despite Drug Cuts, Study Says
The cost of treating cancer has "skyrocketed" despite a 2003 law that sought to control Medicare drug costs, including the cost of chemotherapy, according to a new study. Research published Monday in the Journal of Clinical Oncology found that oncologists did not stop prescribing expensive cancer drugs even after Medicare cut the drugs' reimbursements in 2005. In fact, the aggregate cost of cancer care rose by as much as 60 percent between the passage of the law in 2003 and 2013, the study noted. Cutting drug reimbursements is one way federal health officials seek to influence doctors' prescribing habits (Viebeck, 9/29).

Philadelphia Inquirer: Smoke-Free Subsidized Housing Could Save Nearly $500M
Making all government-subsidized housing in the United States smoke-free could save nearly half a billion dollars a year in health care and housing-related costs, a new study indicates. The total annual savings of $497 million would include $310 million in secondhand smoke-related health care, $134 million in renovation costs and $53 million in smoking-related fire losses, the U.S. Centers for Disease Control and Prevention researchers said. Just banning smoking in public housing either owned or operated by a government housing authority would save $153 million a year, according to the study published Oct. 2 in the journal Preventing Chronic Disease (10/2).

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.